The Tomato Plant

I have never really been good at keeping plants alive, but in the last year, I said I'd give it another go. I bought a rose-bush, a honeysuckle and some tomato seedlings.  They all seem to be thriving, but the plant that has really given me a lot of pleasure is my largest tomato vine. 

It was only a small plant, yay-high when I bought it for a couple of Euro.  I transplanted it into a long window box and positioned it in the sun-trap which is my tiny walled yard.  The first problem was slugs. These little creatures like to nibble on delicate leaves, so after a suggestion from a friend, I cut the bottoms off Guinness cans and filled them with a bit of beer.  Then I left the cans, half buried, next to the tomato seedlings.  The slugs liked the beer (can you blame them?) and drowned in it, the poor cratúrs.  I won't lie to you, I felt a bit bad seeing those little wiggly things in the black beer. In any case, after a few repetitions of that exercise, the slug population dwindled and the plants grew protected under some transparent plastic bags. It reached out its vine branches and found support against bits and pieces of outcrop in the wall.  

This year in Ireland, we've had some lovely sunny stretches, so the tomato plants grew and grew.  I was delighted to see little flowers arrive on the plants and then fruit!  It was exciting to see how the plants sent runners out from one branch to another for stability.  It got me thinking how we humans can also do that and give strength to ourselves by doing supportive things for ourselves.  We can self-support by letting one aspect of our nature or personality support another part of ourself that needs a hand up.  And we can reach out to others too.  

Today I picked my first ruby-red tomato from the vine and I can't describe the immense pleasure it gave me. The vine is now chest high and seems to have at least 15 tomatoes in gestation.  

I feel so proud of that plant!   

Hyper-Arousal and the Inner Child

Life throws stuff at us.  Whether it's problems at work, conflicts in relationships or shortages of money, we adults inevitably have to deal with matters that are unpleasant.  The best thing to do when issues arise, is to evaluate the situation and carefully assess how much emotional energy needs to be expended to solve the problem.  Usually, the  best approach is a logical, evidence based approach in which we carefully evaluate the evidence to hand and then to respond in a manner which helps us to maintain equilibrium and equanimity. Indeed, well-functioning adults seldom panic and they trust that they will find a solution to their problems without panicking, having temper tantrums, obsessive worrying or frightened withdrawal.  In other words, they have the self-confidence to believe that their future selves will be able to regulate situations without panic and anxiety.  When it comes to panic stations, these individuals seldomly worry.  Instead, they evaluate the situation and calmly take approriate action.

Survivors of childjood abuse, whether that abuse was physical, sexual, emotional or mental  in nature, may not be able to achieve this equanimity and instead may find themselves responding inappropriately.  Bobby Deep has a "Star Trek" scale of responses to difficulties.  Amber (yellow) alert means that there is a small problem that needs attention.  An orange alert requires a moderate level of action and alertness, and finally, a red alert is a true emergency that requires swift immediate and sometimes radical action to protect wellbeing or survival.    Green is not an alert.  It simply means that all is peachy and there are currently no problems or reasons to act.  The problem with individuals who have experienced abuse in their earlier lives is that they may have learned to survive by being hypersensistive to danger cues in their environments.  For example, a mildly annoyed look in an abuser's face might have preceded a beating.  Similarly, a slight change of behaviour in an abuser might indicate the possibility of an impending sexual abuse.  Even the slightest nuance of expression might indicate the onset of a tirade of verbal abuse. Therefore, the child learns to survive by predicting these behaviours before they occur. By assessing tiny cues the frightened child was able to prepare  for the inevitable, to hide, or to placate the abuser. At the time,  these behaviours were appropriate responses to the highly inappropriate actions of powerful adults.

People who were abused or neglected in childhood may, in their adult lives, seem highly prescient -- perhaps even psychic because they are able to read the slightest cues in others, based on past patterns of behaviour and circumstance.  Accordingly, they may be able to make predictions about what will happen next or in the future.  Although seeming highly insightful, the price paid is hyper-arousal, hyper-sensitivity,  and anxiety and ultimately depression.  It may be difficult to interact with anyone in a normal manner because every human being has some level of controlled hostility within them.  However, these small and fluctuating hostility emotions are suppressed in order to live sociably and in community.  Most people ignore these tiny tells; but people with a history of abuse may find these difficult to ignore.  Therefore, every interaction could carry within it evidence of the other's instinctual hostility. These tiny cues could trigger anxiety and anticipation of some form of abuse.  Therefore, the individual could project earlier experiences onto a current interactions. Similarly, when difficulties arise, something that only warrants a yellow alert receives a rating of red.   In fact any difficulty receives this evaluation.  In some cases, a yellow alert is allocated when, in fact, all is peaceful, especially when there is a history of neglect.  Accordingly there is seldom emotional rest for such a person. 

So how to stop doing this? Surely, it should be easy to train or teach someone to become desensitized to mild hostility and subtle cues or tiny disturbances in their environments.  Surely, it should be possible to tell the individual: "Stop catastrophising everything! You are creating a storm in a teacup!"  Cognitive Behavioural Therapy (CBT) includes catastrophising as one of the cognitive distortions and therapists using this method will train their clients to recognise instances of catastrophising to help the individual control it.  Of course, there is no harm in this approach, and undoubtedly, it helps individuals.  However, Bobby Deep does not believe that this should be the whole approach.  The problem exists because one or more of the archaic selves, or inner children has suffered a trauma at an earlier time. A current event sets up resonances in our inner children who overwhelm the adult self and begin to respond to the current situation by using a solution that seemed appropriate at an earlier time.  Thus an idividual might withdraw from others, lose the temper, experience deep anxiety, worry, give up, manipulate, become ill, overeat, undereat, self-harm, indulge in some form of risky behaviour; all as a way of escaping a perceived danger.  Ancient resonances overwhelm the current situation and the individual is unable to rationally evaluate the truth of the current situation and take appropriate actions. 

How can we deal with these ancient patterns of coping that impinge on the current self?  Firstly, I believe it is helpful to enter into a healing relationship with a trained therapist who does not only subscribe to CBT.  The therapist should be skilled in entering a therapeutic relationship and help the individual relive earlier traumas in a safe environment.  By doing this, the nervous system of the individual can discharge anxiety caused by earlier trauma carried into the present.  Thus, the past and the present become integrated.  This allows for a gradual calming to occur.  If it is not possible to contract the services of a trained therapist, sometimes it is helpful to read self-help books that safely help us to make contact with our inner children. Discharging this anxiety is really key to helping the current self, overwhelmed by earlier trauma.  

There are other things that can also be done.  The breath is a wonderful reminder of life and the continuity of life.  When we take breath consciously while in a difficult situation, we remind ourselves that life goes on, that we are alive and that we continue to live.  Breathing may also help us to readjust a physical posture that may be preventing the proper circulation of blood.  The back might straighten, the neck muscles relax and all of this helps bring calm to a situation (in fact, any bodily function calms one down).  Then to place the feet firmly on the ground and to remind yourself to stand your ground and "be not afraid".  A third thing to do which is connected to the CBT methods, is to remind yourself that the anxiety is probably a resonance from the past.  That doesn't mean going into that resonance at that moment, because you need your cognition to focus on something else: the evidence at hand.  The fourth step is to evaluate the evidence objectively.  Ask yourself: "What is going on here and now?" In fact, curiosity is a great antidote to anxiety.   Here are the steps in recipe form:

(A)  Breathe and adjust posture;
(B) Ground yourselves with your feet;
(C)  Acknowledge a resonance without going into it;
(D) Evaluate the evidence with curiosity and take appropriate action.

Step C can be brought to a therapist or you can work on it by yourself later to try and understand and discharge the anxiety it might carry.  It is really helpful to listen to the voices of your inner children.  Acknowledge their hurt, frustration or confusion.  Provide support and reassurance as an adult and give them as much love as you possibly can.  Love every part of your self and value every moment of your history.   Happiness and peace from Bobby Deep.

The Inner Child

Every tree has rings that represent annual growth as the seasons alternate between times of plenty and times of scarcity.  In Summer, there is pletny of light, warmth and nutrition, while in Winter, cold keeps only the most basic functions of the tree alive, slowing growth and allowing only for the basic life functions to continue.  The outer rings represent the newest growth and are closest to the surface of the tree, while the more archaic growth lies deeply buried within the core of the tree.  Humans are not that different from trees.  What you see on the surface is the most recent self, newly formed and representing the self as it exists within the present; but what is hidden, is a long line of nested archaic selves, each of whom is as fully alive as the outer form.  Each of us is therefore both like a tree and a Russian Matryoshka doll; a set of nested selves, each of whom is fully alive and influencing how the current self, the outermost Matryoshka doll is functioning. 

 How can this be?  Surely I am not many selves?  Of course that is true.  Each of us is an undivided unity of being; but like the single tree, there is a dendrochronology -  a tree time in which the layers of the self together allow the present self to emerge, whole and apparently coherent.  However, there are many of who do not always feel very whole or coherent.  There may be a sense that there is something about the inner rings, or perhaps the not-so-inner rings that seems wrong.  Somehow or other, it may seem that these rings have not laid themselves down in a manner allowing for each new ring to rest peacefully and neatly upon the last.  It may be that one of the Matryoshka dolls embedded within the larger current self is unhappy, for lo -- we hear it crying bitterly and secretly from within the belly.  Or it may remain silent until it finds itself in the vulnerability of loving another.

The inner selves, particularly those from an earlier, more helpless and vulnerable time, may not have received the care, nurturance and kindness that they were rightfully expecting.  Perhaps, instead of nurturing, they received a slap, or worse,  a beating when they cried.  Or perhaps, expecting to be fed, were left for long swathes of time to experience unremitting hunger or thrist.  Or perhaps they were frightened and unable to deal with the loneliness brought on by neglect; or perhaps they were exposed to constant conflict between their main caregivers.  By being abused or neglected; by not learning to trust, these little inner babushkas froze in time and now will not stop crying.  We hear their muffled cries through the dendrochronological layers, but instead of listening to their suffering, we shut their cries out with: cigarettes, alcohol, marijuana, music, sex, overeating, novels, movies, chocolate and parties.  This is a sad thing because that inner babushka needs to be heard and it also needs minding and care; and if it never received enough of what it needed back then,  it is in the interests of the outer Matryoshka to somehow take care of its needs in the present.

Here's the thing.  We are not trees; nor are we painted wooden dolls.  We are multi-dimensional flesh-and-blood human beings who have our joy or suffer in the present moment, and is only in the present that healing may occur. It can only occur as the present, ongoing self makes loving contact with that archaic inner child.  

Ask yourself:  if my younger four-year old self (or any other age) was here with me right now, what would he or she want?  What might they say? What would he or she need? What material things could I give that child? What emotional needs could I meet?  What assurances are needed? Perhaps you will be surprised by the reality of this little you and the  answers you might receive.  Bobby Deep can always imagine the clothing of his inner little boy.  

Love that little child at whatever age it appears to you; be aware of its flesh and blood presence.  The inner child is not a theoretical construct, but a living being; and it would do you well to take care of this child who may be influencing your overall wellbeing from the inside out.  

Situational inertia

Hello this is Bobby Deep and today I would like to explore some things that could stop us from in implementing change in our lives.

Many of us will want to implement change in our lives because we are not satisfied with the way things are.  Perhaps we want to be free of addiction, or perhaps we want to change the way we structure our days, or want to eat more healthily, or change the way we interact with people.  Inevitably we believe that changes will bring us more happiness or a better quality of life.  Indeed, we may want change because we have realised our worth.  However,  there are things that might hinder progress.

There is a force of nature called inertia.  In physics,this refers to the property of all matter that has mass, In which things that are at rest tend to remain at rest, while things that are in motion, tend to remain in motion.  Simply put, it takes energy to get something to start moving.  Similarly, it takes energy to get something to stop moving. This law seems to apply in the psychological dimensions also.  What I mean is that if you wish to initiate  a new way of being in your life, it may require that you put considerable energy into doing so.  Similarly, if you wish to stop doing something, it may also take considerable energy to stop doing it.

For example, you may have realised your sense of self-worth, or you have developed some self-esteem.  Consequently, you may have decided to mind your own well being.  Perhaps you are trying to engage more with life, or to develop your social environment.  However the people around you may not realise that something has changed  within you. At the sane time, you may no longer respond in ways you use to respond to people.  Take for example someone who has quit alcohol or smoking.  

Skull smoking a cigarette - Vincent Van Gogh  

Previously, the smoker or alcoholic may have responded to social invitations in a particular manner.  After they have withdrawn from a substance, they may no longer respond in the same manner.  Thus, the people around them may read the mew behaviours as strange or unusual.  Unfortunately, (or fortunately) these surprised friends will either withdraw their friendship or discourage the new behaviours.  This then puts the person attempting changes to return to previous unwanted behaviours. Therefore, the loss of friendships and relationships could accompany changes in self-concept or behaviour.  In fact, a changed relationship to one thing could lead to changes in other relationships.  I refer to this as situational inertia.  

All of us exist in psychological and social equilibrium.  In other words, we live in a system of interactions between ourselves and the world.  Therefore, it is not surprising that when we change something inside ourselves, that we may upset the equilibrium outside ourselves.  So do not be surprised when the changes you implement create crises for you.  These crises may occur gradually or they may occur suddenly and simultaneously.  Sometimes the stress they in evoke in us may lead us to return to previous unwanted attitudes, beliefs and behaviours.  

So how can we avoid this problem?  One way to avoid this kind of situational inertia, is too predict and to plan for it.  In other words, we need to have a roadmap for change that includes the possibility that the relationships we have formed, may change as we change our relationships to other things in our lives.  It also involves trusting that we will be open to new and more healthy relationships.  In short, it means that we need to have courage.  But courage does not exclude the possibility of being gentle and tender with ourselves. Each of us has immeasurable value, and each of us has a right to implement changes to make us more whole.  

When everything seems to be going wrong, it's important to ask ourselves the question is this because I have changed my relationship to something?  In fact, what seems catastrophic at one instant in time may, on reflection, later prove to be a blessing in disguise.  I invite you to conduct a thought experiment.  Think back to your past And remember a time when something catastrophic happened.  At the time, you may have thought the event was something awful and terrible.  Now try and imagine your life without that event having occurred.  I suggest that in many cases you will realise that the catastrophic event was in fact a catalyst for an opportunity or for something good.  You are probably aware of the saying that when one door closes another door opens.  I have experienced people saying this to me in the past, and found a little flippant.  However, when I look back, it's  inevitably true.  I am not denying that bad things can happen and do have long-term term negative consequences.  However, it is useful to think back and reflect on how something catastrophic turned out to be positive in the long term.

So I am urging courage on your part, and I am asking you to consider that what You see as catastrophic may in fact not be.  Perhaps this universe In which we find ourselves is actually quite a friendly place!  I wish you warmth and goodness.   

Narcissistic Rage

Hello it's Bobby Deep here again and I have decided to discuss something that I find both  interesting and quite disturbing.  In one of my previous posts I wrote about narcissism and people who are narcissistic.  In this post I would like to write anout the kinds of things that could happen when narcissism dominates the personality of the individual.

I will start with the usual caveat that all people have some level of narcissism in them. Indeed, a certain level of selfishness is necessary for the purposes of self-preservation and survival.  However, we need to also show some selflessness in order to function socially.  Although Immediate selfishness may bring short term pay-offs, its overuse may sabotage any long term benefits.  In a way, selflessness and giving to others helps guarantee our embededness within a particular social context over a longer period.  In other words, those who are kind are more likely to have kindness shown to them.  Of course, this is not guaranteed.  But perhaps kindness has evolved to provide us with credit in our social account and thus promotes longevity.  However, people who have stronger narcissistic traits have great difficulty trusting that short term giving without a corresponding immediate pay back might result in longer term pay offs.  

In order to identify what such individuals might look like,  i am providing som typical traits below.  

(A) A poorly developed or absent sense of empathy;  they have feelings of their own but struggle or don't care to imagine  what another is feeling.  

(B)  A sense of misplaced grandiosity;  a sense of superiority and being better than others;

(C) A sense of entitlement;

(D) Exploitativeness; 

(E)  Self-centredness;  the conversation must focus on them;

(F) Lack of forgiveness;

You will find different ways of characterising this problem, but these seem the most salient to me.  In the past, this kind of individual would have been called a megalomaniac. If these traits are pronounced enough,  the person could be said to have a narcissistic personality disorder (NPD).  However, such a diagnosis is a very serious matter and should only be conducted  by qualified individuals.  Usually, five out of nine traits need to be firmly present for such a diagnosis.

Narcissists can be very charming and often very pleasant on the eye.  Also, they have every appearance of being a typical nice guy or gal, without any obvious negative characteristics.  But they are excellent mimics and know exactly how to act in a social situation, by presenting an amalgam of personality characteristics that are replicated from other people. Ironically, although they see themselves as unique, the personality they portray is a hodge-podge of others' personalities. Nevertheless, this amalgam is extremely hard to detect and only those with finely honed phoniness detectors will sense they are speaking to a synthetic persona. 

Sadly, the real person behind the mask exists only in a stunted or vestigial form.

  

Smeagol in The Lord of the Rings, reminds me of the Narcissistic vestigial self. 

This ossified genuine self is unable to present itself to the world but has its needs obtained by controlling its simulacrum.    It is hungry for one thing and one thing only:  a constant supply of unconditional positive attention from whomever the narcissist believes has the credibility to issue such regard and praise.  They therefore suck up to their betters and vilify their apparent inferiors. 

Narcissists could move the people in their lives around like objects without regard for their needs.  In fact, the needs of others play no part in the calculations narcissists make with regard to the best yields of positive attention.  One thing is certain: they do it for themselves and for no one else.  Therefore,  they are extremely selfish and stingy and are likely to be in complete control of finances..  Often, the gifts narcissists give are given to keep the target "sweet" or hooked; and these gifts will often be a little  off-target with regard to the likes and preferences of the rare recipient.  The narcissist is often a poor gift giver because it is too effortful to imagine what someone else might like or want.  Even when given precise instructions, they might get it wrong, some believe because they deliberately want to torture the recipient.  But I think this is more likely due to a reluctance to prioritise the other's needs; as torture requires imagining what might frustrate the gift recipient.  In contrast, they are very aware of their own frustrations.

Narcissists cannot and do not tolerate even the smallest amount of criticism without becoming enraged. Rage is not anger.  Rage is the experience of suddenly and unexpectedly loss of power.  Being accustomed to controlling their supply of positive attention and regard, and obsequious placating behaviours from others, any departure from established patterns can severely unhinge the narcissist.  This is very exhausting for the people who live with or  who relate to them. It is impossible to be genuine with them and to give them honest  feedback about your feelings about them or their specific behaviours, because you will elicit a rage response.  This rage is likely to be absolute, hateful and deeply unsettling for the recipient,whether  the rage is cold or more outspoken.  Such toxic displays of rage can have consequences to the well-being of others.  Thus the narcissist who is unable to express who they really are, force others to do the same. 

Here are a few more behaviours that you might see with someone who has a narcissistic personality disorder or tendencies towards it. They choose to have relationships with people who have some form of vulnerability.  However it is very important for them to choose people who also have some claim to fame or some set of skills or social recognition. Narcissist always do their homework before engaging in any form of relationship with anyone.  So for example, they might use search engines or social networking websites to find a target's CV, This enables them to check out a target's social value.  They could become obsessed with an individual in this process.  It's a type of infatuation which precedes the actual meeting with individual.  When they eventually do meet up with the person or manipulate the target  into some form of interaction, they are completely infatuated with that individual, and may very quickly learn what the other person needs from a psychological perspective.  Then, they will proceed to act in a manner that meets the needs of the target. Thus the narcissist presents the target with a very potent set of social behaviours that addict the target. For example, the  target may feel completely understood and that they have found somebody who really meets their needs. Accordingly, their  defences will fall and this is precisely what upsets  the narcissist. 

As the target's defences come down, the narcissist starts despising the target. Being unable themselves to enter a vulnerable state in which the true self can  be shown, the narcissist is disturbed by the target's vulnerability.  The annoyance caused  by this loss of an idealised object leads the narcissist to start undermining the target and to withdraw any form of affection.  Unfortunately the target is now addicted to the narcissist and is likely to experience withdrawal symptoms.  Most likely these individuals will then engage in placatory or begging behaviour to try and coax the original behaviours out of the narcissist. But this only serves to enrage them further as a sign of phoniness: their idealised target is now a whimpering, begging fool; someone who deserves only contempt.  Ironically, the phoney barcissist, unable to present a true self to the   world cannot integrate the strengths and weaknesses of their idealised target.  In other words, they cannot see them as a blend of strength and vulnerability because for the narcissist there is only either good or bad, black or white, with no intermediate gradations.  Nor is there an understanding of process and how time regulates process.

If the target has the audacity to criticise him, the narcissist will punish the target by either withdrawing completely or engaging in utter vilification and enraged vituperative language, the force of which stands in stark contrast to the original obsessed infatuation. However, this rage does not only damage the target but also the narcissist.  As they engage in splitting the personality of the target from idealised to vilified, they themselves become split from the position of infatuated joy to a primal sense of frustration and rage which takes a toll on them.  

Although very toxic, these individuals cannot be said to be evil. They can however cause a lot of unnecessary suffering.  Unfortunately, their personality development has been stunted at quite an early age, either by neglect, over exposure to parental conflict or exposure to parents who were unable to teach the child to regulate their feelings and emotions, mostly because they neglected the child's needs. 

If you believe you have been exposed to a narcissist I suggestion you get some psychotherapeutic assistance to help you deal with your feelings and to work out strategies that support you.  Similarly, if you recognise traits of narcissism in yourself, realise that awareness is not enough.  Seek help and be one of the few who do something to try and free themselves from the painful cycles of infatuation, devaluing, rage and disappointment.  Become healthier, balanced and more functional as you seek to heal and love your true hidden self. 

All or Nothing Thinking

Although I have criticised Cognitive BehaviouralTherapy (CBT), it has some fantastic tools that allow one to challenge your thinking.  Briefly, CBT is based on the idea that much of our suffering is due to distorted thinking and faulty logic.  As you know, I believe that it is not enough to address faulty logic without also addressing relationships.  However, let's assume that you are taking care of that side of things, and look at one distorted thought process, namely "All or Nothing" thinking, which is also called "Black and White" thinking.

All  or nothing thinking happens when an individual characterises an object, the self or others as either totally wonderful or completely evil, without recognising that all things and people exist on continua that vary according to:

 (a) context;

(b)  stages of a process/development

(c) energy/resource availability;

(d) short term and long term needs;

(e) insight and knowledge.

In general,  nothing is perfect or imperfect because, as the Buddhists say, everything is in a constant state of flux; everything is changing; and everything that exists is in process. The notion of perfection or imperfection is a human construct which assumes that there is some pre-existing and overarching standard or pattern, separate from the human collective consciousness, against which things and people can be tested.  

This assumption is probably rooted in our primitive instincts.  As a newborn, we are only able to experience the absolute joy of having our needs met (nursing); or being utterly overwhelmed by our immediate needs being unmet (crying for the breast).  These ideas were first put forward by Melanie Klein, an English psychoanalytic theorist in the early 20th Century, who is credited as being the first children's psychotherapist and who wrote on the topic of "object relations". She wrote about how the reflexive infant splits experiences into a good breast or a bad breast.  This splitting results in the infant existing in binary states and in which they are either experiencing either total joy or total suffering.  Thus both the part representation of the mother (breast) and the self are split into two.  

Crying in response to hunger holds survival value because it signals need.  However, as time passes,  the infant who has his needs met learns that the breast sometimes provides and sometimes withholds;  and the developing personality learns to trust the process of life.  Freud said that depending on the quality of care, people carry with them into adulthood either a hostile or idealised infantile prototype.  In other words he noticed that individuals exist on a continuum that ranges from a tendency to project an ideal onto other people, or they project hostility (evil) onto others.  

Some people switch suddenly between these extremes, without integrating people or situations into their grey in-betweens which depend, I believe, on the factors I mentioned in the list above.  

Therefore, awareness of all or nothing thinking challenges us to see things in a balanced way.  In order to be whole,happy and Integrated we need to be able to see things in and people as wholes and in constant process.  By avoiding black and white thinking, we are better able to respond to things as they really are, rather than what we believe they should or should not be.  This requires the nurturing of gentleness and kindness towards ourselves and to others.

Administrationalism and its Relentless Drag on the Advancement of Civilisation

Bobby Deep has never been a fan of beaurocracy. Besides from the obvious inconvenience of jumping through paper hoops like a circus poodle,  he doesnt like the pernicious power of administrative systems that take away from the power and efficiency of the core business of any creative endeavour.  

Of course businesses and public services need administrative systems to make them work.  But uncontrolled administrationalism I believe is one of the central reasons why many state-run endeavours are in trouble worldwide in this early part of the 21st Century.

Let me tell you a story.  There are many similar stories, but hopefully, it will highlight one of the biggest problems we face in this amazing era of science and technology.

The Diabetes Unit

Once upon a time there was a diabetes unit in a beautiful kingdom.  It was staffed by five very cable specialist doctors and two rehab therapists.  The unit was very busy and had one administrator and two secretarial staff.  The unit was busy but functional and the people working there were happy.  

One day, the national health executive decided to restructure the then-current unit system to an "integrated health flow system", a term coined by the minister of health who thought it was a very good idea. He had after all won his seat in parliament on the slogan: 'Modern efficiency for all!.'

A wise wizard had let the minister of health know that the latest international buzzwords was "integrated health flow system".  So he decided that such a system was necessary.  It needed specialist administrators and accordingly created new administrative posts for ex-units. Posts were advertised, and as you may expect, most existing administrators re-applied for there own jobs.  None of them got these posts and each was faced with a choice:  leave or accept a sideways demotion. Salaries would remain the same, so most opted for the latter option.  

It was a busy time.  The new administrators were hired, and unsurprisingly, they proceeded to implement new "quality and flow efficiency measures" and a raft of new policies for the clinicians to follow.  For example,  they noted that all the clinicians used paper files and so implemented new computer systems to augment the paper file systems.  This meant that all clinicians had to keep paper AND computer records.  In addition, in line with new policies, doctors had to fill in new pink forms for each test they ordered with a clear rationale for the order.  On receipt of the test, the doctor would need to fill in a green form and a duplicate computer form to prove that results had been actioned.

The therapists had to follow similar protocols.  Instead of direct ordering via secretarial staff, therapists were now required to make orders to the central head office for health appliances.  For example if a therapist had to order 50 pressure gadgets they had to be ordered on the computer system which would issue an order number. Each gadget would be assigned a serial number which would be allocated to a particular computer file on fitting, and accordingly the therapist's stock would be updated.  

On occasions, the central office would forward an order to a manufacturer who might only be able to fulfill a partial order. Thus only 40 out of 50 appliances might arrive, but unfortunately it would be only possible to accept a whole order on the computer and impossible to allocate appliances to patient files without full accepting of the stock.  Thus the therapist would need to keep a special discrepancies log.  

Therapists complained that they were spending a full day a week managing stock and computer systems but the new administrator felt that the secretarial staff were already overwhelmed processing the new pink and green forms the doctors were now completing.  The new administrator felt that a new secretary was justified on a part time basis to cope with the heavy administrative load of the local diabetes health flow system.  The new secretary would manage the growing waiting list and act as a public relations officer for the growing number of complaints from the public.

In the mean time, the previous administrator decided It was time to implement a quality review program of the health flow system. Subsequently each member of staff would have to complete a detailed review of their health practices within the system and justify the use of each hour of their work week.  The second administrator had his eye on a new post in head office and was pleased of the opportunity to implement a quality improvement planned for the system.  All medical staff found that their work week has lengthened and that they were  working overtime without extra pay.  Waiting lists had also lengthened and the minister of health couldn't understand why both costs and waiting list had almost doubled. It just dint make sense. So he decided to send an auditor to the diabetes unit to sort matters out... 

A decision was taken to create a moratorium on new posts.  So when one secretary took maternity leave, her post was not covered.  Similarly, when a doctor and therapist each took sick leave for anxiety-related illness, they could not be replaced.

The End.

The story you have read is what I believe is one of the key factors that makes living in the 21st century often so frustrating.  It paints a picture of what I believe often happens in modern work systems; and which results in a bloated and expensive public service.  Not to mention the human stress, the waste of time, and the control of professions by people who have no real concept of the actual purpose of the work carried out.  The consequences of this are as follows:

1.  Severely decreased availability of funds for core-business activities, like continuing professional development of coal-face staff.  

2.  Reduced funds for updating instrumentation and new methods.

3.  Demoralisation and consequent suppression of innovation and research by workers.

4.  Burnout, exhaustion, illness and an increase in error rates.

5. A rise in customer alienation and dissatisfaction.

6.  Decision -making about and prioritization of core-business activities either forced or heavily influenced by unqualified administrators. What some people call the tail wagging the dog.

It really is disheartening that in this age of science, technological advancement and amazing discovery, that administrationalism is dragging its feet kicking and screaming into the future.  Bobby Deep, doesn't complain often, but he ain't got no time for dat.